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In a provocative article, an Italian medical professor argues that Pope John Paul II didn't just simply slip away as his weakness and illness overtook him in April 2005. Intensive care specialist Dr. Lina Pavanelli has concluded that the ailing Pope's April 2 death was caused by what the Catholic Church itself would consider euthanasia. She bases this conclusion on her medical expertise and her own observations of the ailing pontiff on television, as well as press reports and a subsequent book by John Paul's personal physician. The failure to insert a feeding tube into the patient until just a few days before he died accelerated John Paul's death, Pavanelli concludes. Moreover, Pavanelli says she believes that the Pope's doctors dutifully explained the situation to him, and thus she surmises that it was the pontiff himself who likely refused the feeding tube after he'd been twice rushed to the hospital in February and March. Catholics are enjoined to pursue all means to prolong life. (See pictures by John Paul's late photographer)

The article, entitled "The Sweet Death of Karol Wojtyla" (using the Pope's birth name) appears in the latest edition of Micromega, a highbrow Italian bi-monthly that has frequently criticized the Vatican's stance on bioethics. The author, who heads the anesthesiology and intensive care therapy school at the University of Ferrara, says she decided to revisit the events around John Paul's death after the Vatican took a hard line in a controversy last year in Italy over euthanasia. Indeed her accusations are grave, questioning the Catholic Church's strictly traditional stances on medical ethics, including the dictum from John Paul's own 1995 encyclical Evangelium Vitae to use all modern means possible to avoid death. (See the cover of the commemorative issue honoring John Paul's passing)

Recalling the Vatican's medical reports during John Paul's last days, Pavanelli writes: "I'm surprised that I myself failed to critically examine the information. I let my perceptions conform to the hope of recovery and the official version, without confronting the clinical signs that I was seeing." While the Vatican had expressed most of its concern about breathing difficulty, which was alleviated with a tracheotomy, Pavanelli says a readily apparent loss of weight, and an apparent difficulty to swallow, was not being addressed. "The patient had died for reasons that were clearly not mentioned. Of all the problems of the complicated clinical picture of the patient, the acute respiratory insufficiency was not the principal threat to the life of the patient. The Pope was dying from another consequence of the effects on the [throat] muscles from his Parkinson's Disease... not treated: the incapacity to swallow."

The Vatican quickly fired back this week. John Paul's longtime doctor Renato Buzzonetti, who now monitors Pope Benedict XVI, said that doctors and John Paul himself all acted to stave off death. "His treatment was never interrupted," Buzzonetti told the Rome daily La Repubblica. "Anyone who says otherwise is mistaken." He added that a permanent nasal feeding tube was inserted three days before the Pope's death when he could no longer sufficiently ingest food or liquids. Buzzonetti did not specifically respond to Pavanelli's claim that John Paul needed a tube weeks, not days, before he eventually died.

The polemics come just as the Vatican again weighed in on euthanasia. The Church's doctrinal office released a one-page document, approved by Benedict, that denounced the cutting off of food and water to patients in a vegetative state even if they would never regain consciousness. This reaffirmed John Paul's stance in 2004 during the battle over ending artificial feeding for the severely brain-damaged Terri Schiavo, who was later taken off her feeding tube and died.

"The administration of food and water even by artificial means is, in principle, an ordinary means of preserving life," said the Vatican ruling, which came in response to questions from the U.S. Catholic Bishops Conference about what constitutes ordinary and extraordinary life support.

The issue of euthanasia and the Church heated up in Italy last year after a man named Piergiorgio Welby, who'd been on life support for nine years from the effects of muscular dystrophy, asked for the right to die. Eventually, the life support was suspended and he died. But when his wife, a practicing Catholic, asked for a funeral in Church, the Vatican refused. Pavanelli says that this episode prompted her to revisit John Paul's death.

The medical aspects of the Pope's final days are clearly difficult to verify from afar, and the Vatican is convinced that the actions of the both its doctors and its Pope were in absolute good faith. Of course, medical opinions can often vary. So too can those on bioethics.